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General NPI Number Information
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NPI Number | 1598250425
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Entity Type | Individual
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Provider Name | RAED AMJAD HUSSEIN QARAJEH MD
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Gender | Male
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Dates
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Enumeration Date | 06/23/2018
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Last Update Date | 06/13/2022
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Provider Practice Location Address
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Address Line | 1717 W CONGRESS PKWY
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City | CHICAGO
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State | IL
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Zip | 60612-3809
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Country | US
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Telephone | 312-563-7473
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Fax |
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Provider Business Mailing Address
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Address Line | 1717 W CONGRESS PKWY
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City | CHICAGO
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State | IL
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Zip | 60612-3809
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Country | US
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Telephone | 312-563-7473
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 2021025578
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | 036.160339
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License Number State | IL
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